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A 75 y. old First admission : 06/2006 Past history CHD S/P CABG 2003 COPD

A 75 y. old First admission : 06/2006 Past history CHD S/P CABG 2003 COPD Dyslipidemia S/P CVA 1998. Laboratory data Hb: 9gr/dl WBC: 3500 per cumm Creat: 3-5 mg/dl B 2 Mc : 6700 mg/ml CRP 6mg/L Severe hypogamma globulinemia

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A 75 y. old First admission : 06/2006 Past history CHD S/P CABG 2003 COPD

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  1. A 75 y. old First admission : 06/2006 Past history CHD S/P CABG 2003 COPD Dyslipidemia S/P CVA 1998

  2. Laboratory data • Hb: 9gr/dl • WBC: 3500 per cumm • Creat: 3-5 mg/dl • B2Mc : 6700 mg/ml • CRP 6mg/L • Severe hypogamma globulinemia • FLC: light chain Kappa 1820mg/dl • BM : 80% plasma cells • Low radiation CT: Multiple Lytic lesions

  3. Diagnosis: Light chain Myeloma Treatment : 2 courses Dexametazone (40mgx4d) Marked improvement in clinical and lab. parameters

  4. Follow up • Velcade + Dexametazone (every 21 days) x 6 courses Discontinued due to: • Peripheral neuropathy + Rec. chest infections

  5. April 2008 - Readmission • Hb – 9.0 gm/dl • WBC – 100.000 percumm • Platelets – 70.000 percumm • >80% plasma cells in P.B and B.M • FLC – light chain kappa 3000mg/dl • Creatinine : 6mg/dl • Uric acid: 14mg/dl • Urea - 300mg/dl • Treatment : Dialysis + Cyclophosphamide and Dexameazone x 2 courses Marked improvement in clinical and lab. parameters

  6. HOW TO CONTINUE TO MANAGE THIS CASE?

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